INFLUENCE OF MAJOR SURGICAL STRESS ON PLASMA TESTOSTERONE, PLASMA LH AND URINARY STEROIDS

1972 ◽  
Vol 69 (3) ◽  
pp. 542-552 ◽  
Author(s):  
Y. Monden ◽  
K. Koshiyama ◽  
H. Tanaka ◽  
S. Mizutani ◽  
T. Aono ◽  
...  
Keyword(s):  
Marked Decrease ◽  
Surgical Stress ◽  
Major Surgery ◽  
Plasma Testosterone ◽  
Pulmonary Lobectomy ◽  
Adrenal Androgens ◽  
Testosterone Secretion ◽  
Urinary Steroids ◽  
Post Operative Period ◽  
Male Patients

ABSTRACT Plasma testosterone levels were determined in 42 male patients both before 1, 2, 3, 4, 6, 8 and 12 weeks following pulmonary lobectomy. The plasma LH was measured in 13 of the 42 patients. There was a significant fall in the plasma levels of testosterone 1, 2 and 3 weeks after the pulmonary lobectomy but the levels returned to the control values from the fourth post-operative week onward. On the other hand, the level of plasma LH increased significantly one week after the operation when the plasma testosterone showed the most marked decrease. The urinary 17-KS and 17-OHCS were measured in 27 of the 42 male patients, both before and 1, 4, 8 and 12 weeks after the operation. The total 17-KS was found to be significantly decreased 1, 4 and 8 weeks after the operation. The post-operative decrease resulted from a significant decrease in the excretion of C19O2-17-KS on the seventh postoperative day but thereafter the decrease mainly resulted from a decrease in C19O3-17-KS. It is suggested that testosterone secretion from the testes seems to decrease for 3 weeks after major surgery. The decrease in the excretion of 17-KS observed after this post-operative period is caused by a decrease in the excretion of metabolites from adrenal androgens.

PLASMA TESTOSTERONE LEVELS FOLLOWING SURGICAL STRESS IN MALE PATIENTS

1970 ◽  
Vol 65 (1) ◽  
pp. 11-17 ◽  
Author(s):  
K. Matsumoto ◽  
K. Takeyasu ◽  
S. Mizutani ◽  
Y. Hamanaka ◽  
T. Uozumi
Keyword(s):  
Postoperative Period ◽  
Plasma Levels ◽  
Surgical Stress ◽  
Control Level ◽  
Major Surgery ◽  
Plasma Testosterone ◽  
Blood Samples ◽  
Testosterone Levels ◽  
Competitive Protein Binding ◽  
Male Patients

ABSTRACT Plasma testosterone levels were determined by the competitive protein binding method of Mayes & Nugent (1968) with slight modifications, in 20 male patients in whom moderate or major surgery had been performed. Preoperative (control) and postoperative blood samples were obtained at 8 a. m. except for immediate postoperative samples. There was a significant decrease in the plasma levels of testosterone immediately and 2 days after moderate and major surgery. The level of testosterone returned toward the control level on the sixth postoperative day after moderate surgery, while after major surgery, the decreased plasma testosterone was maintained for at least 6 days. It is suggested that testicular secretion of testosterone seems to decrease during the postoperative period.

EFFECTS OF GENERAL ANAESTHESIA AND SEVERITY OF SURGICAL STRESS ON SERUM LH AND TESTOSTERONE IN MALES

1975 ◽  
Vol 78 (2) ◽  
pp. 258-269 ◽  
Author(s):  
A. Nakashima ◽  
K. Koshiyama ◽  
T. Uozumi ◽  
Y. Monden ◽  
Y. Hamanaka ◽  
...  
Keyword(s):  
General Anaesthesia ◽  
Surgical Stress ◽  
Fiberoptic Bronchoscopy ◽  
Serum Testosterone ◽  
Major Surgery ◽  
Succinylcholine Chloride ◽  
Serum Luteinizing Hormone ◽  
Serum Lh ◽  
Rate Of Increase ◽  
Male Patients

ABSTRACT Significantly decreased levels of serum testosterone from the pre-anaesthesia level were found during and up to 7 days following major surgery under general anaesthesia (nitrous oxide, oxygen and halothane following induction with thiopental and succinylcholine chloride) in 18 male patients. On the other hand, in the same patients, the serum luteinizing hormone (LH) increased significantly from the pre-anaesthesia level 30 min and 1 h after the beginning of anaesthesia. A slight increase in LH level was also noted on the 7th post-operative day. The determinations of serum testosterone and LH in fiberoptic bronchoscopy under the same general anaesthesia as that used in surgery or local anaesthesia in 26 male patients, revealed that the change in the serum LH during and following surgery seemed to be mainly induced by the general anaesthesia and that the rate of decrease in the serum testosterone may be related to the severity of surgical stress including the anaesthesia. The rate of increase in serum testosterone following the injection of gonadotrophin in 20 males on the 6th post-operative day was similar to that in 10 pre-operative males. The effects of pulmonary lobectomy on serum testosterone and urinary steroids were also studied in 6 males under adrenal suppression with dexamethasone. On the 6th post-operative day, the urinary aetiocholanolone plus androsterone and serum testosterone were found to be half the level of those on the pre-operative day, while the urinary 5β-pregnane-3α,17α,20α-triol remained unchanged. These observations in human are not inconsistent with the report of Tcholakian & Eik-Nes (1971) in dogs namely that a shift in androgen biosynthetic pathway is present in the testis under surgical stress.

PLASMA CORTISOL, CORTICOSTERONE AND NON-PROTEIN-BOUND CORTISOL IN EXTRACORPOREAL CIRCULATION

1972 ◽  
Vol 69 (3) ◽  
pp. 517-525 ◽  
Author(s):  
T. Uozumi ◽  
H. Manabe ◽  
Y. Kawashima ◽  
Y. Hamanaka ◽  
Y. Monden ◽  
...  
Keyword(s):  
Cortisol Level ◽  
Extracorporeal Circulation ◽  
Plasma Cortisol ◽  
Elevated Level ◽  
Marked Decrease ◽  
Binding Capacity ◽  
Biologically Active ◽  
Major Surgery ◽  
Plasma Samples ◽  
Effective Factor

ABSTRACT The response of plasma cortisol, corticosterone and non-protein-bound cortisol in the extracorporeal circulation was investigated in 14 patients. The pre-perfusion levels of plasma cortisol, corticosterone and non-protein-bound cortisol were significantly elevated. During and immediately after perfusion, the levels of cortisol and corticosterone were found to decrease significantly from the pre-perfusion levels, while the percentage of non-protein-bound cortisol was shown to increase significantly. This indicates a marked decrease in cortisol binding capacity of plasma during extracorporeal circulation. Moreover in 200 plasma samples, it was demonstrated that the cortisol level increased markedly and the cortisol binding capacity decreased slightly during and shortly after major surgery without perfusion. It is concluded that stressful situations in major surgery with or without perfusion are associated with markedly increased levels of biologically active non-protein-bound cortisol. The elevated level of non-protein-bound cortisol in surgery seems to be dependent on the increase in the level of plasma cortisol as well as on the decrease in the cortisol binding capacity of plasma. Although the increased plasma cortisol plays the most important role in surgery with no perfusion, the decreased cortisol binding capacity may be the more effective factor involved during perfusion.

scholarly journals Scoring systems for early prediction of tibial fracture non-union: an update

2021 ◽  
Author(s):  
George D. Chloros ◽  
Nikolaos K. Kanakaris ◽  
James S. H. Vun ◽  
Anthony Howard ◽  
Peter V. Giannoudis
Keyword(s):  
Tibial Fracture ◽  
Scoring Systems ◽  
Trauma Centre ◽  
Predictive Values ◽  
Non Union ◽  
Post Operative Period ◽  
Male Patients ◽  
Level I ◽  
Healing Score ◽  
Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

scholarly journals Postoperative Albumin Drop Is a Marker for Surgical Stress and a Predictor for Clinical Outcome: A Pilot Study

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Martin Hübner ◽  
Styliani Mantziari ◽  
Nicolas Demartines ◽  
François Pralong ◽  
Pauline Coti-Bertrand ◽  
...  
Keyword(s):  
Stress Response ◽  
Pilot Study ◽  
Clinical Outcomes ◽  
Surgical Stress ◽  
Major Surgery ◽  
Surgical Trauma ◽  
Once Daily ◽  
Reactive Protein ◽  
Estimated Blood Loss ◽  
Postoperative Stress

Background. Surgical stress during major surgery may be related to adverse clinical outcomes and early quantification of stress response would be useful to allow prompt interventions. The aim of this study was to evaluate the acute phase protein albumin in the context of the postoperative stress response.Methods. This prospective pilot study included 70 patients undergoing frequent abdominal procedures of different magnitude. Albumin (Alb) and C-reactive protein (CRP) levels were measured once daily starting the day before surgery until postoperative day (POD) 5. Maximal Alb decrease (Alb Δ min) was correlated with clinical parameters of surgical stress, postoperative complications, and length of stay.Results. Albumin values dropped immediately after surgery by about 10 g/L (42.2±4.5 g/L preoperativelyversus33.8±5.3 g/L at day 1,P<0.001). Alb Δ min was correlated with operation length (Pearsonρ=0.470,P<0.001), estimated blood loss (ρ=0.605,P<0.001), and maximal CRP values (ρ=0.391,P=0.002). Alb Δ min levels were significantly higher in patients having complications (10.0±5.4versus6.1±5.2,P=0.005) and a longer hospital stay (ρ=0.285,P<0.020).Conclusion. Early postoperative albumin drop appeared to reflect the magnitude of surgical trauma and was correlated with adverse clinical outcomes. Its promising role as early marker for stress response deserves further prospective evaluation.

Altered Fibrinolysis during and after Surgery

2021 ◽  
Author(s):  
Maria J. Colomina ◽  
Esther Méndez ◽  
Antoni Sabate
Keyword(s):  
Surgical Stress ◽  
Point Of Care ◽  
Vena Cava ◽  
Coagulation Factors ◽  
Major Surgery ◽  
Fibrinogen Concentration ◽  
Tissue Destruction ◽  
Inflammatory Reactions ◽  
Hematological Disorders ◽  
Number Of Patients

AbstractMajor surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a “physiologic” hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.

scholarly journals Surgical stress detection in human blood plasma by DSC

2020 ◽  
Vol 142 (2) ◽  
pp. 783-788 ◽  
Author(s):  
Andrea Ferencz ◽  
Dénes Lőrinczy
Keyword(s):  
Blood Loss ◽  
Blood Plasma ◽  
Surgical Intervention ◽  
Surgical Stress ◽  
Venous Blood ◽  
Operation Time ◽  
Major Surgery ◽  
Human Blood Plasma ◽  
Thermal Transitions ◽  
Surgical Interventions

Abstract It is a well-known fact that the extension of the surgical intervention influences both the success and time of the patient’s recovery, the degree of the blood loss, i.e., overall the patients’ surgical burden. Disease itself determines extent of surgical procedure (minor, intermediate or major surgery), which affects the risk and frequency of complications. Previous works have contributed to the validation of differential scanning calorimetry (DSC) as a potential non-invasive tool for diagnosing and monitoring several illnesses. Hence, the main goal of this study was to measure the effect of each surgical intervention on its own to blood plasma composition. Peripheral venous blood samples were collected from patients who underwent minor (n = 8), intermediate (n = 9) and major surgical interventions (n = 7). According our DSC data of blood plasma components, from the thermodynamic parameters, namely from the thermal transitions (Tm1–Tm8) to calorimetric enthalpy (ΔHcal) in proportion corresponded to the size of surgical interventions (duration of operation time, length of incision, surgical intraoperative stress, blood loss, etc.). This examination has shown that intraoperative stress during any surgical intervention affects the composition of plasma proteins, which should be always considered in the evaluation of DSC results in any surgical study.

Urologic surgery in hemophiliac patients

1996 ◽  
Vol 63 (1_suppl) ◽  
pp. 120-123
Author(s):  
G. Anselmo ◽  
A. Fandella ◽  
F. Merlo ◽  
E. Cicerello ◽  
L. Maccatrozzo
Keyword(s):  
Septic Shock ◽  
Adrenal Adenoma ◽  
Team Work ◽  
Major Surgery ◽  
Ureteral Stones ◽  
Post Operative Period ◽  
Operative Complications ◽  
Viii And Ix ◽  
Surgical Recovery

Hemophilia is an extremely interesting pathology for urologists, given the frequent involvement of the urogenital apparatus in these patients (hematuria and spontaneous hematomas - especially retroperitoneal, pathologies caused by clots in the urinary tract, etc.). From 1976 to 1995 we treated 17 patients: 15 (12 hemophiliac A and 3 B) for major and minor urological pathologies (3 prostatic hyperplasias of which 1 with bladder lithiasis, 1 adrenal adenoma, 1 nephrectomy for post-pyelolithotomy urinous fistula, 3 ureteral stones, 1 pyelic stone, 5 phimoses, 1 hydrocele) and 2 (hemophiliac A) with ESWL. 16 patients had no post-operative complications nor problems during follow-up (mean 86 months). 1 patient died the fourth day after nephrectomy due to septic shock and uncontrollable hemorrhage. The purpose of therapy in all the operated patients was to raise the level of factor VIII and IX to over 60% of the normal value and to keep it above 30% during the post-operative period until full surgical recovery. Only close team-work with hematologists and transfusionists, with at least temporary correction of hemostatic parameters plus special measures, will permit major surgery to be performed.

THE EFFECT OF CYPROTERONE ACETATE ON THE PLASMA GONADOTROPHIN RESPONSE TO GONADOTROPHIN RELEASING HORMONE

1976 ◽  
Vol 81 (3) ◽  
pp. 680-684 ◽  
Author(s):  
Richard A. Donald ◽  
Eric A. Espiner ◽  
R. John Cowles ◽  
Joy E. Fazackerley
Keyword(s):  
Testosterone Level ◽  
Cyproterone Acetate ◽  
Luteinising Hormone ◽  
Follicle Stimulating Hormone ◽  
Plasma Testosterone ◽  
Plasma Testosterone Level ◽  
Releasing Hormone ◽  
Lh Release ◽  
Gonadotrophin Releasing Hormone ◽  
Male Patients

ABSTRACT Cyproterone acetate (100–150 mg daily) was administered to 8 male patients with excessive libido. Within 3 months a significant fall (P < 0.02) in plasma testosterone was demonstrated. The plasma luteinising hormone (LH) and follicle stimulating hormone (FSH) responses to gonadotrophin releasing hormone (LH/FSH-RH) were also significantly impaired (P < 0.05). A direct correlation between the resting plasma testosterone level and the LH response to LH/FSH-RH was demonstrated (r = 0.743). It is concluded that the fall in plasma testosterone levels in patients receiving cyproterone acetate may be attributed to suppression of LH release, rather than an antiandrogen effect on the testis or hypothalamus.

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